Family name and first name:	*
Identity card number / Tax identification number:	*
Telephone:	*
Lecture Student  Administration / Services Staff  Others   *
Causes:   *
Actions undertaken and documents provided:
Request:
Data Provision Authorisation: I hereby authorise the University Ombudsman to provide the corresponding University competence with any data deemed necessary whenever it be so required for the resolution of my request: (YES/NO)  *
Date:
Email address to which reply is to be sent:	*
-In accordance with the Spanish Act on Personal Database Protection (Ley Orgánica 15/1999 de Protección de Datos de Caracter Personal), you are hereby informed that your personal data, contained in the present claim / consultation document, will be collected and processed in the automatic filing system: University Ombudsman, in order for the necessary steps to be taken regards your claim/consultation, and to enable the Ombudsman to carry out his duties properly. -Likewise, you are informed that you are entitled to exercise your rights of access, rectification, cancelation and objection, referred to in the said Law, by means of a formal written request, accompanied by a photocopy of your Identity Card, sent to service responsible for the filing system : the University Ombudsman, Law Faculty Building, 2nd Floor, Avenida de los Castros s/n, 39005 Santander, either via its Registry or by registered mail.

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